To describe the clinical spectrum of cryoglobulinemic vasculitis (CV) in primary Sjögren's syndrome (pSS), investigate its relation to lymphoma and identify the differences with hepatitis C virus (HCV) related CV.
From a multicentre study population of consecutive pSS patients, those who had been evaluated for cryoglobulins and fulfilled the 2011 classification criteria for CV were identified retrospectively. pSS-CV patients were matched with pSS patients without cryoglobulins (12) and HCV-CV patients (11). Clinical, laboratory and outcome features were analyzed. A data driven logistic regression model was applied for pSS-CV patients and their pSS cryoglobulin negative controls to identify independent features associated with lymphoma.
1083 pSS patients were tested for cryoglobulins. 115 (10.6%) had cryoglobulinemia and 71 (6.5%) fulfilled the classification criteria for CV. pSS-CV patients had higher frequency of extraglandular manifestations and lymphoma (OR=9.87, 95% CI 4.7-20.9) compared to pSS patil phenotype of pSS.To assess interstitial lung disease (ILD) risk among patients newly diagnosed with systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis (RA), dermatomyositis (DMtis), polymyositis (PM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS).
Using the 1997-2013 Taiwanese National Health Insurance Research Database, we identified 62,930 newly diagnosed SARD patients from 2001 to 2013. We selected 251,720 individuals without SARD diagnoses who were matched (14) with SARD patients by age, sex and year of index date. We compared the incidence rates (IRs) of ILD (consistent diagnosis with ICD-9 code 515, 516.3, 516.8, 516.9 or 517 after a ILD-related radiological or pathological procedure) between the specific SARD subgroups and the corresponding non-SARD comparison groups. Using multivariable Cox regression analyses, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of ILD in the various SARD groups compared with comparison groups after adjusting for age, sex and Charlson comorbidity index.
The IR of ILD was greatest among patients with SSc (1,364 per 10years), followed by DMtis (1,011 per 10years), PM (831 per 10years), pSS (196 per 10years), RA (109 per 10years) and SLE (120 per 10years). Multivariable analyses showed that the risk of ILD was increased among patients with SSc (HR, 172.63), DMtis (HR, 119.61), PM (HR, 84.89), SLE (HR, 32.18), pSS (HR, 17.54), or RA (HR, 8.29).
This population-based, cohort study demonstrates that the risk of ILD is significantly increased in patients with newly diagnosed SARDs.
This population-based, cohort study demonstrates that the risk of ILD is significantly increased in patients with newly diagnosed SARDs.To evaluate mortality trends in polymyositis (PM) and dermatomyositis (DM) between January 1, 1997, and December 31, 2014.
Using an administrative health database from the province of British Columbia, Canada, we identified all patients with incident PM/DM and up to 10 age-, sex-, and index date matched non-PM/DM individuals. https://www.selleckchem.com/products/eft-508.html Study cohorts for both PM and DM were divided into two subgroups based on the year of diagnosis (i.e., early cohort [1997-2005] and late cohort [2006-2014]). Mortality rates, hazard ratios (HRs), and rate differences were compared between these cohorts.
Mortality rates (per 1000 person-years) in the early cohorts for PM and DM patients were higher than those in the late cohorts (for PM 58.6 vs. 39.4; for DM 80.6 vs. 51.3), whereas smaller improvements were observed in the comparison cohorts (for non-PM 15.5 vs. 12.5; for non-DM 14.1 vs. 11.5). Corresponding to these two time periods, multivariable HRs for PM were 2.4 (95% CI, 1.7 to 3.4) and 2.0 (95% CI, 1.4 to 2.9), respectively (P-value for interaction=0.62). The corresponding absolute mortality rate differences were 32.6 (95% CI, 20.8 to 44.4) and 18.6 (95% CI, 9.2 to 28.0), respectively (P-value for interaction=0.02). Similar results with higher HRs and risk differences were seen in DM.
In this general population study, we found a declining excess mortality in PM or DM patients in recent years, although there was a considerable residual premature mortality gap in the late cohort.
In this general population study, we found a declining excess mortality in PM or DM patients in recent years, although there was a considerable residual premature mortality gap in the late cohort.To investigate the longitudinal relationship between trabecular bone loss and spinal progression in axial spondyloarthritis (axSpA).
Patients enrolled in the Incheon Saint Mary's axSpA prospective observational cohort were evaluated. The number of syndesmophytes was assessed by two trained readers at baseline and at 2 and 4 years follow-up. Trabecular bone loss was assessed using the trabecular bone score (TBS). Disease activity measures included the BASDAI, ASDAS, CRP, and ESR. The relationship between trabecular bone loss and radiographic damage was investigated using generalized estimating equation models with 2 year time lags.
Of the 245 patients included (80% males; mean (SD) age, 37 (12) years), 26 (11%) had mild trabecular bone loss (1.23-1.31) and 25 (10%) had severe trabecular bone loss (?1.23) at baseline. Trabecular bone loss was associated with longitudinal radiographic spinal progression. Those with severe trabecular bone loss at baseline had an average 0.42 more syndesmophytes/2 years than those with normal TBS. Multivariate analysis revealed that severe trabecular bone loss compared with normal TBS resulted in an additional 0.4 syndesmophytes over 2 years. Adjusting for significant clinical factors revealed that both mild and severe trabecular bone loss were independent risk factors for new syndesmophyte formation over the next 2 years (OR [95% CI]=2.4 [1.1-5.1]) and OR [95% CI]=4.0 [1.6-9.7], respectively).
Trabecular bone loss is longitudinally associated with spinal progression of axSpA. The more severe the trabecular bone loss, the stronger the effect on the progression of the spine.
Trabecular bone loss is longitudinally associated with spinal progression of axSpA. The more severe the trabecular bone loss, the stronger the effect on the progression of the spine.